Abstract
Purpose: We report the usefulness of navigation surgery using the indocyanine green (ICG) fluorescence method to discover metastatic and primary lesions of hepatoblastoma.
Method: Seven pediatric hepatoblastoma cases were analyzed. Operations included partial lung resection for multiple lung metastases (n=1), extirpation for mediastinal lymph node metastasis (n=1), hepatectomies for primary or recurrent hepatoblastoma (n=4), and liver transplantation for recurrent disease (n=1). ICG (0.5 mg/kg) was administered intravenously to all patients 24 hours prior to surgery. Fluorescence emitted by ICG in the tumor tissue was portrayed by Photodynamic Eye (PDE)®.
Results: Eight lung metastatic lesions were identified by this method and extirpated. The smallest lesion, which was not palpable, was 0.4 mm in diameter. This method could distinguish a mediastinal metastatic lymph node from other normal nodes. Primary liver tumors, which were exposed to the liver surface, emitted fluorescence; however deep lesions were not detectable. We could not confirm residual tumor in the stump of residual liver by this method. The gallbladder and extrahepatic bile ducts were depicted well. We applied ICG as a non-radioactive contrast medium to confirm bile leakage from the stump of the liver.
Conclusion: This method is extremely useful to discover metastatic lesions of hepatoblastoma in the lung and lymph nodes. Moreover, this is a useful method to discover residual lesions in the liver of primary hepatoblastoma.
